President's Message

Dear SRS members,

Greetings again from Chicago, where the summer is enjoyable and the city is vibrant. I hope you are all enjoying your summer and family gatherings. On the other hand, the summer is a very busy time for the Scoliosis Research Society (SRS) leadership and staff completing the tasks of the year and preparing for the 48th Annual Meeting & Course, which will be in Lyon, France September 18-21, 2013. I would like to invite all of you to attend the meeting and the Pre-Course. The outstanding work of the Education Committee, chaired by John R. Dimar II, MD and the Program Committee, chaired by Suken A. Shah, MD assures us that we will have a great meeting with valuable education programs and exchange of the latest in research. It is a global meeting with presentations and faculty from different regions of the world. The registration is very strong, which speaks loudly of the significance of our educational programs. Lyon is a historic city, which is designated as a United Nations Organization for Education, Science and Culture (UNESCO) World Heritage Site. Enjoy the versatile culture of Lyon and its unique cuisine and wine. Lyon is known as the Gastronomic Capital of the World! French culture will be incorporated into the meeting from the social events to the guest activities. Friday night’s Farewell Reception at “Les Halles de Lyon-Paul Bocuse” is unique to Lyon. This roofed market opened in 1971 and is home to over 55 different vendors including wine, chocolate, cheese and traditional dishes. All guests will be invited to sample offerings from each vendor at no additional cost. Lyon promises to be an unforgettable experience.

Every year, the highlight of the summer for SRS is the IMAST meeting, and this year was not any different as the 20th Annual International Meeting on Advanced Spine Techniques (IMAST) in Vancouver, BC, Canada, July 10-13 was a great success. There were 764 attendees, who enjoyed an outstanding educational program and social activities. The new format of two-minute short podium presentations was well received and conducted without any glitches. This format was added this year to accommodate more papers from the record submission of more than 1400 abstracts. You will read more details under Christopher I. Shaffrey, MD’s IMAST Report, which is included in this newsletter. Congratulation to Dr. Shaffrey, Justin S. Smith, MD and the IMAST committee on this great success and my sincere appreciation for the time and hard work they put into planning this outstanding IMAST meeting. My sincere thanks also go to Cydni Schaeffler on this successful meeting, which was her first as SRS Meetings Manager. I would encourage you all to attend the 21st IMAST meeting on July 16-19, next year in Valencia, Spain.

This is my final newsletter to you as President, and I would like to briefly update you on some of this year’s activities.

Between IMAST in July and the Annual Meeting in September, the committees and task forces are busy working to complete their goals for this year. We had a very productive year, thanks to the diligent and hard work of the committees and task forces. The Presidential Line (PL) had the chance to meet with every committee chair at least once during the year in the PL weekly conference calls. These calls are very valuable in keeping the PL informed in a timely fashion about the committees work and maintaining an open line of communication with the committees. In addition to the calls, the council chairs keep good correspondence and coordination between each council’s committees. Some of the committees are reporting in this newsletter. I hope you will read their reports and feel proud of your great organization, which attributes its success to the sincere and significant involvement of the majority of its members.

The Award Committee, chaired by Lawrence L. Haber, MD completed its task by awarding a record number of 26 awards. More information on the winners can be found on the SRS website. The Research Grant Committee is currently completing its selection for the Spring Cycle grants. The board budgeted $170 thousand for each of the Spring and the Fall Cycles, which includes the new Stacy Lewis Research Grant. The Website Committee is going through the final stages of an animated surgery video for the patients and families to be posted on the website. The Worldwide Conference Committee is busy completing a record number of six courses in 2013. I attended the Valencia course, which was arranged in conjunction with The SILACO (Spanish Speaking Spine Societies) meeting. I am pleased to report to you that the course was very well attended and received, and it was of the highest educational value. Thanks to the co-chairs of the course, Mark Weidenbaum, MD and Hani Mhaidli, MD for their hard work in arranging this outstanding event. Two more courses are planned for this year; a course in Sarajevo, Bosnia-Herzegovina in conjunction with the Balkan Spine Society November 1 - 2 and the final course in Beijing in conjunction with The Chinese Orthopedic Association meeting on November 7. The Global Outreach Committee has established a well-needed site in Marrakesh, Morocco, which quickly became a popular site with many of the members expressing interest in being involved. The Continuing Medical Education (CME) Committee is busy reviewing all presentations and talks to assure the absence of any biases and Conflicts of Interests. We now offer our own CME credits and will be applying next year for the formal accreditation after completing the provisional period. The Non-Operative Committee worked hard to plan a Half-Day Course in Lyon in conjunction with International Society on Scoliosis Orthopaedic Rehabilitation and Treatment (SOSORT). The course will cover all Non-Operative Treatment with a global perspective. These activities are but a few of the committees’ achievements this year.

The SRS Surgical Safety Initiative continues to be an important topic for the Society. The Surgical Safety Task Force, chaired by Kit M. Song, MD, MHA will present a checklist in Lyon to be utilized when changes occur in the neuromonitoring during deformity surgery. Pediatric Orthopaedic Society of North America (POSNA) is working on a similar project, chaired by Michael G. Vitale, MD, MPH and we are coordinating our efforts and have arranged a strategic planning group from both organizations to explore further safety enhancement projects. This group consists of Dr. Vitale and James McCarthy, MD (POSNA), and Dr. Song and myself (SRS). Steven D. Glassman, MD, the SRS coming President, is also interested in the same project and will support the continued exploration of different modalities to enhance surgical safety.

As I have mentioned in my previous communications, I would like to encourage all of you to donate to the SRS Research, Education, and Outreach Fund, (REO Fund). Your gift will ensure the continuous success and strength of this great Society. Our goal is to have all members participate regardless of the amount. I would like to fulfill the 100x100 slogan this year: 100% participation for as little as $100. You can add this contribution to the registration of the Annual Meeting.

I would like to take this opportunity to recognize all members who keep SRS progressing on track and contribute to its success. We now have 34 Committees and 10 Taskforces, which have been busy fulfilling their charges and diligently completing any added responsibilities during this year. I sincerely thank all committee and task force chairs and members for their dedication and tireless efforts.

As my Presidency year comes to completion at the conclusion of the Lyon Annual Meeting, I will pass the baton to the very capable coming President, Steve D. Glassman, MD, who will lead this organization to further success.

In closing, I would like to thank the Presidential Line: President-Elect, Steve D. Glassman, MD; Vice President, John P. Dormans, MD and Past President B. Stephens Richards, III, MDfor their continuous support, advice and help. My sincere appreciation goes to the Board of Directors for all their help and support. I also express my sincere gratitude to our very competent staff under the leadership of the Executive Director, Tressa Goulding. Their dedication, expertise, and hard work are exemplary.

Obituary

Craig Brigham, MD

Craig Donald Brigham, MD, of Charlotte, died suddenly on Monday, April 22, 2013, of a pulmonary embolism. Brigham, an orthopaedic spine surgeon at Charlotte's OrthoCarolina Spine Center, was 58. Dr. Brigham was born on May 6, 1954 in Portland, Oregon, son of the late George and Val Ennis Brigham. He had a truly amazing life, which in his youth began with excellence in athletics and this resulted in a full track scholarship at the University of Oregon. In 1976, he was rated 8th in the world in the decathlon. Brigham earned a BS degree in General Science from the University of Oregon in 1976. He received his MD degree from Northwestern University Medical School in 1980, and did both his internship and residency at Northwestern University McGaw Medical Center. His additional training included a fellowship in spine surgery under Edward H. Simmons, MD, at the State University of New York at Buffalo. Brigham's hospital appointments were at the Carolinas Medical Center-Main and the Presbyterian Orthopaedic Hospital, both of Charlotte. His academic appointments, professional awards, research grants, publications and presentations all helped shape a full and indeed exceptional medical career.

He was Chief of Spine Surgery at Carolinas Medical Center (CMC) and headed the Orthopaedic Residency Program. He received two teaching awards from the CMC's residency program. His prolific list of publications included his most recent article, "Cervical Spinal Cord Contusion in Professional Athletes: A Case Series with Implications for Return to Play," for the journal Spine, February 15, 2013, in collaboration with J. Capo. Beyond his numerous professional accomplishments, what shaped Brigham's medical career most of all was his dedication to the highest medical ethics and his firm commitment to practicing medicine guided entirely by what he thought was in the best interests of his patients. Simply stated, Brigham was directed by science, by a great generosity of human care and concern, and by the weighty responsibility of his patients' health. To this end he was assisted by his boundless energy, childlike wonderment with the world, a brilliant medical mind and his skilled hands.

Brigham is survived by his wife Joan Brigham, MD, daughter Ms. Emily Brigham, and daughter Mrs. Faith Brigham Leener of New York City. Also surviving are his two brothers, Ron Brigham of Portland, Oregon, and Glen Brigham of Eugene, Oregon. In partnership with Dr. Brigham's family, the OrthoCarolina Foundation has established the Dr. Craig Brigham Memorial Fund. The Memorial Fund will be a fitting tribute to his lasting legacy of orthopedic excellence by promoting and furthering the field or orthopedics through education and evidence-based learning.

Obituary

Jay Nogi, MD

Dr. Jay Nogi, 66, of Richmond, Va., died on March 21, 2013. He was preceded in death by his parents, the late Seymour and Minnie Fish Nogi.

He is survived by his wife of 45 years, Sandra Dolinger Nogi; daughter, Jill Nogi and her husband, Dan Addess; and son, Scott Nogi and his wife, Haley Channing; grandsons, Jacob and Evan Addess; sister, Janet Nogi Moskovitz; several nieces and nephews.

Dr. Nogi, a former resident of Scranton, graduated from the University of Rochester, Phi Beta Kappa and Jefferson Medical College, completed his residency training at University of Virginia and Pediatric Orthopedic Fellowship at the A.I. duPont Institute, Wilmington, Del. He served his country in the U.S. Army Medical Corps. He was president of the Virginia Orthopedic Society, a member of the Pediatric Orthopedic Society of North America, the American Academy of Orthopedical Surgeons, the American Academy of Cerebral Palsy and Developmental Medicine, the Virginia Orthopedic Society, the Richmond Academy of Medicine, the Scoliosis Research Society and the Medical Society of Virginia. He served on a task force for the Office of the Governor. Dr. Nogi practiced at MCV and Children's Hospital for 25 years. He served as the Beverley B. Clary, Professor of Pediatric Orthopedic Surgery at the Medical College of Virginia and was Surgeon-in-Chief, Director, Pediatric Orthopedic Services at Children's Hospital.

Dr. Nogi enjoyed spending time with his family and was known for his great sense of humor. He was an avid reader, supporter of the arts, enjoyed playing golf and traveled extensively with his wife. He was an active member of the Jewish Community.

The family would like to thank the physicians and staff of Henrico Doctors Hospital for the loving care provided to Dr. Nogi over the years.

Obituary

Victor Rositto, MD

Victor Rositto has recently passed away and it was sad news for all that knew him.

Victor has deeply collaborated with SRS since he joined in 1989. He was one of the Local Hosts of the 39th Annual Meeting held in Buenos Aires and he took part of the Worldwide Conference Committee as well.

Dr. Rositto worked intensively in the treatment of spinal deformities in childhood with an increased focus on neurological diseases. He was the Chairman of the Spine Unit in the Hospital de Niños of Buenos Aires and he was also President of the Argentine Spine Society.

Victor Rositto has been a good and thorough orthopedic surgeon and will always be remembered.

Prepared by Carlos A. Tello, MD

HISTORIAN CORNER: REMEMBERING PIERRE STAGNARA (1917–1995)

Behrooz A. Akbarnia, M.D.
Historical Committee Chair

As our upcoming 2013, 48th Annual Meeting & Course will be held in Lyon, France, I felt it would be appropriate to honor a son of Lyon, Pierre Stagnara, M.D. in this issue. I first met Dr. Stagnara in 1975, when I was a fellow and he was visiting the Twin Cities Scoliosis Center. I was very excited and happy to finally meet him as his name was mentioned almost every day during my fellowship: the Stagnara wake-up test, Stagnara view, Stagnara cast and brace, and his techniques in the treatment of severe adult spinal deformity. I would like to thank Jean Dubousset, Bob Winter, Ron DeWald and Pierre Roussouly as well as members of the Historical Committee for providing material, allowing me to complete this article.

Pierre and Denise Stagnara (1977)

Born in Loriol, France in 1917, Dr. Stagnara became internationally known for many accomplishments in the field of spinal surgery. He attended medical school in Lyon and, after World War II, became a senior resident with Maurice Guilleminet in Lyon. Stagnara founded the Spinal Department of the Livet Foundation before becoming Chief of the “Centre des Massues” from 1959 until his retirement in 1982. Pierre was happily married to Denise and together they raised ten wonderful children. After his retirement, he and his wife wrote a wonderful book entitled Faithful Love, Utopia or Reality? (1989), demonstrating their philosophy in life.

In his 1996 tribute to Dr. Stagnara (Spine 21/18: 2176–77), Jean Dubousset states that the study of spinal deformities was Dr. Stagnara’s life’s work, including the classic report on scoliosis published in the French Society of Orthopaedic and Trauma Surgery (SOFCOT) in 1954. Stagnara was the first to establish an organized nonsurgical approach to manage scoliosis with casts and braces, now referred to as the Lyonssais Treatment. His Centre focused on the entire field of spine pathology utilizing a multidisciplinary approach.

Rotational Deformity as measuredby Stagnara

Stagnara was one of the first to surgically treat complex adult deformity, which led to the development of the Stagnara wake-up test in 1973 with the help of his anesthesiologist Mme. Vauzelle; this test is still used today.

Stagnara continues to be well known both in literature and through his colleagues. As Ron DeWald states, “Dr. Stagnara presented his ‘wake-up technique’ [at the Lyon meeting 40 years ago], and at first, we couldn't quite believe what we were hearing. It was a revelation that we in the USA quickly adopted.”

Bob Winter recalls “Stagnara was a Harrington guest lecturer and spoke about treating adults with terrible spine deformities. I think the average curve was 150°. He is the person who taught us about ‘kyphosing scoliosis.’”

Pierre Stagnara will remain an important figure in the developing history of spine deformity surgery and as the current Historian of the SRS, it is my honor to present this tribute to our members.

Research Council Update

Kenneth MC Cheung, MD
Research Council Chair

The Research Council is made up by chairs of the following committees: Adult Deformity; Evidence based outcomes; Growing Spine; Mortality and Morbidity; Non-operative Management; Research Grant; and 3D Scoliosis.

As Chair of the Research Council, I was appointed on a four-year term. I am a voting member of the Board of Directors and I attend all Board of Directors meetings. My duties are to report to the Board of Directors, activities of the member committees and to act as one channel of communication between the Board of Directors and the committees. I try to attend as many of the committee meetings and conference calls as possible, and provide guidance to the committees regarding ideas discussed at Board of Directors level. In addition, the Council Chair is aware of actions of individual committees, and therefore can facilitate work between committees to enhance efficiency and reduce overlap.

Each year, at the Annual Meeting & Course, I am responsible for providing a summary of activities carried out by the individual committees at the member’s business meeting and to take suggestions and questions. Indeed, if members have any suggestions for me, I would be very happy to hear from you via email.

Education Council Report

Daniel J. Sucato, MD, MS
Education Council Chair

The Scoliosis Research Society continues to be fully committed to education with great efforts to promote our Society’s expertise in all we do. There have been significant efforts over the past year which are highlighted below. As the chair of the Education Council, I have been proud to watch all of the great accomplishments that have taken place for the Awards & Scholarships, CME, Education, E-Text, Global Outreach, Patient Education, Website, Program, World Wide Courses and IMAST committees. A separate report of the Global Outreach and IMAST committees are in the current newsletter.

The Awards Committee chaired by Lawrence Haber MD, has done an enormous job reviewing the applications and selecting the awards for this year. This year’s Lifetime Achievement Award winners are George H. Thompson, MD and Ian A. F. Stokes, PhD. We congratulate them on this prestigious award. The Walter P. Blount Humanitarian Award went to Bettye A. Wright, PA, RN for all of her great work in providing spinal care in developing countries. The Edgar G. Dawson Fellowship recipient was Han Jo Kim, MD and the GOP Educational Scholarships were awarded to Hrutvig Rajendra Bhatt, MD; Andrei Joaquim, MD; Naveen Tahasildar, MD; Gaurav Raj Dhakal, MD; Ahmad Allam, MD; Ndubuisi Ebere Duru, MD while the GOP Visiting Fellowships went to Fady Michael Ibrahim, MD; Tie Liu, MD; Kawu Ahidjo Abdulhadin, FWACS and Tomas Rolando Minueza Mejia, MD. Finally, the Eduardo R. Luque Award went to Javier Pizones, MD, PhD. Three new awards were voted on this year: The Robert B. Winter Global Outreach Fellowship was given to Krishna Kumar Ramachandran Nair, MD; the OrthoPediatric North American Resident/Fellow Meeting Scholarship was given to Elias Dakwar, MD; Andrew Pugely, MD; Robert Murphy, MD; Michael Merrick, MD; Brian Kaufman, MD; Courtney O’Donnell, MD; Avrum Joffe, MD; Brett Lafleur, MD while the OrthoPaediatric International Pediatric Travelling Fellowship was given to Mohsen Karami, MD and Miclos Tunyogi-Csapo MD. Congratulations to all of these well-deserving winners.

The CME Committee under the direction of Frank Schwab, MD has been busy at work monitoring the content for the SRS Annual Meeting and for IMAST. This a very time intensive process that includes a pre-meeting evaluation of the abstracts, which may result in a request for the presentation slides by the reviewers to fully evaluate for important conflicts of interest. The committee has worked hard to inform our membership regarding conflict of interest while providing the greatest educational content within the Accreditation Council for Continuing Medical Education (ACCME) guidelines. The COI review process for the 2012 Annual Meeting generated several warning letters, which the committee managed according to an ACCME approved protocol. As we move toward our next ACCME accreditation review, the CME committee is modifying our protocols to include a formal appeals process for future occurrences. The committee is pleased to report no violations of the COI at the 2013 IMAST meeting. The CME committee continues to look for opportunities to provide CME credit for its membership which has resulted in the first-time CME credit for the Lunchtime Symposium at the Annual Meeting in Lyon. Great job to Dr. Schwab and his committee.

The Education Committee, chaired by John R. Dimar II, MD has once-again done an incredible job putting together a robust educational program for the upcoming year. The Pre-Meeting Course will be a reflection of the continued globalization effort of the SRS and is entitled “A Global Perspective of the Management of Spinal Disease & Deformity” and will include a wide-range of topics in spinal deformity with invited speakers from throughout the world. The Half-Day Course will be “Spinal Deformity in Myelomeningocele”, “Nonoperative Spinal Deformity Treatment Techniques” and “Sagittal Plane Deformity”. The Lunchtime Symposium will be 2013 Global Outreach-Update on “How to Start it and How to Treat a Site”, “A Global Perspective on Neuromonitoring”, “Lifelong Radiology Exposure for Spine Surgery- Can We Do Better?”, “Research Grant Outcomes”, “The Research Process: From Asking to Answering and Culture of Safety in Your Operating Room”. The committee submitted applications to the AAOS for Symposia Presentation and were successful in getting “Loss of Standing Balance: The Lifelong (cradle to Grave) Management of Sagittal Imbalance of the Spine” accepted to the 2013 program. Finally, the committee has organized the SRS portion of the FOSA program for the AAOS meeting. The Education Committee has also contributed significantly to the SRS Website, providing content in the area of Adult Spinal Deformity. As you can see this is a very busy and productive committee and congratulations go out to Dr. Dimar and his team.

The E-Text Committee, chaired by Praveen Mummaneni, MD has been hard at work soliciting author updates for all of the chapters of the E-Text. A strong effort has been made to add video content such as physical examination findings and surgical techniques to the chapters to add educational value. The committee will be looking for opportunities to capture and collect video from members as well as at ongoing SRS educational events such as the Cadaver Course to include in the E-Text. An exciting initiative is the I-book version of the E-Text to allow readers immediate access via their iPhone or iPad. Ongoing efforts are in place to publicize the E-Text through the various SRS committees including, the Education, Website, Advocacy, etc. The E-Text continues to be a popular educational resource with over 1000 viewers in the last 18 months!

The Program Committee, led by Suken Shah, MD has put together an exciting program. There were over 1400 abstracts submitted this year, another record number. All abstracts were reviewed by eight reviewers who graded the abstracts and the scores were tabulated after throwing out the best and worst score. The committee then put together the best papers for Podium Presentation. Once again this year, there will be concurrent sessions occurring during the early Friday morning allowing for an additional 15 papers presented at the meeting. The two session topics are “Early Onset Scoliosis” and “Adult Spine Deformity”. The Hibbs Award Papers are once again outstanding and will be grouped together Friday following the lunch break. Membership voting for these prestigious awards will be via a smartphone app which you can load up now at http://eventmobi.com/srsam13. The very popular Roundtable Case Discussions will continue this year with four main topics: Cervical, Congenital Scoliosis, Kyphosis and Neurologic Complications. The Program Committee has put together a very exciting and educational Annual Meeting.

The Patient Education Committee, chaired by Raymond Knapp, MD has been busy at work updating SRS-sponsored brochures on scoliosis and kyphosis that are popular with patients and primary care physicians. The committee has reviewed the FAQ’s on the website and updated them. The committee has reviewed a proposal from Medikidz, an on-line site for children, to edit their comic book on scoliosis and has approved the project and is assisting with content and editing. The committee continues to participate in the review and edit of the patient information content on the website.

The SRS Website Committee, chaired by Anthony Rinella, MD has been very busy with many projects to maintain a fresh and vibrant website. An exciting new project, in combination with the Patient Education Committee, is an animation of surgical correction of thoracic scoliosis which is ready for launch having received recent board approval. This animation will provide patients and their families with a general overview of how correction of scoliosis is performed. The website has stayed very current with all of the happenings at the SRS and its related activities with a latest news section on the right side of the home page. There are many links from the website including the ability to connect to the new Spine Deformity journal (a lead banner has been included on the website). Because the SRS is a global society, sections of the website have been translated into other languages with currently six languages (Arabic, Chinese, French, Spanish, Japanese and Portuguese) represented. The website renovation includes an array of patient’s success stories as well as an improved interface for patients and families. Facebook continues to be very popular with a doubling of the number of “friends” of the SRS and more than 1700 “Likes” since February 2013. Upcoming projects include an upgrade to the member search function, creating a photo journal of previous SRS Travelling Fellow trips, and working with the CME Committee to develop web-based CME opportunities. The website continues to be a popular site for all search engines appearing on the first page when “scoliosis” is searched. Please visit the SRS website and send your patients there for outstanding up-to-date information!

As you can see, it has been a very successful educational year for the Scoliosis Research Society. Congratulations to all of the chairs, committee members and the outstanding staff at the SRS office for making this possible.

IMAST Update and Recap

Christopher I. Shaffrey, MD
IMAST Committee Chair

A very successful 20th International Meeting on Advanced Spine Techniques was recently held on July 10-13, 2013 at the Vancouver Convention Center in Vancouver, British Columbia. Both the venue and weather were outstanding and contributed to the success of the event. The IMAST meeting continues to be a great success with over 750 total attendees with 525 medical registrants. There was widespread international participation with over half of the physicians coming from outside of North America. Registrants from 32 different countries attended the meeting with particularly strong representation from Japan, Peoples Republic of China, Japan, India, Thailand and Singapore.

An IMAST taskforce was commissioned by the SRS Presidential Line to improve the breadth, scope and content of the IMAST meeting. Some of the changes incorporated into the 20th IMAST meeting included a more balanced program with one third of the program devoted to degenerative conditions of the entire spine, one third focused on trauma, tumor and infection related topics and limiting one third of the program to spinal deformity. The IMAST committee consisting of Jacob M. Buchowski, MD; Kenneth M.C. Cheung, MD; Samuel K. Cho, MD; Benny T. Dahl, MD, PhD, DMSci; John R. Dimar, MD; Patrick C. Hsieh, MD, MSc ; Andrew H. Jea, MD; Panagiotis G. Korovessis, MD, PhD; Toshiaki Kotani, MD, PhD; Morio Matsumoto, MD; Frank Schwab, Frank J. Schwab, MD; and Daniel J. Sucato, MD, MS, generated the well-received scientific program. Using the reviews from the last two IMAST meetings, there was an increase in the number of instructional course lectures and debates included in this year’s program. Some of the more popular Instructional Course Lectures included: "Management of Metastatic Spine Disease", "Emerging Technologies in Spine Surgery", "Adult Deformity: Surgical Planning & Techniques", "Pediatric Deformity: Surgical Planning & Techniques and Management of Primary Spine Tumors". Two of the Roundtable Sessions, that were particularly well received, were "Ethical Dilemmas in Spinal Surgery" and "Controversies in Physician and Industry Relations".

There were over 1500 abstracts submitted in 2013 from which 185 papers where accepted for presentation. The paper presentations covered the entire spectrum of spinal pathology and were the principle source of the outstanding scientific program. There were numerous highly rated papers considered for the Whitecloud Awards. "Surgical Treatment of Pathological Loss of Lumbar Lordosis (Flatback) in the Setting of Normal Sagittal Vertical Axis (SVA) Achieves Similar Clinical Improvement as Surgical Treatment for Elevated SVA" presented by Justin S. Smith, MD, won the Whitecloud Award for the Best Clinical Paper while "Effect of Intermittent Administration of Teriparatide(PTH1-34) on BMP Induced Bone Formation in a Rat Spinal Fusion Model" presented by Takashi Kaito, MD, PhD; won the Whitecloud Basic Science Award.

Responding to suggestions of prior meeting attendees who were having increasing difficulty attending meetings with only poster presentations, two-minute point presentations were added with a reduction in the number of posters accepted. Fifty-one two-minute point presentations that were limited to six slides each were presented. This format worked extremely well and got almost universally favorable reviews on the evaluations.

A popular aspect of the IMAST program is the multiple Concurrent Sessions occurring simultaneously. The Concurrent Sessions allow each of the attendees to tailor the scientific program to optimize the learning experience. Several of the historically most popular sessions are presented on two occasions. It is recognized that sometimes there are two or more sessions occurring at the same time that are of interest. In order to address this, the entirety of the scientific program has been videotaped and archived on the SRS website where it will be available to the SRS membership and all IMAST attendees.

Planning has already started for the 21st IMAST meeting that will be held on July 16-19, 2014 in Valencia, Spain. Valencia is located on the western seacoast of Spain, on the banks of the Turia River and the Gulf of Valencia. It is known for fantastic weather, exciting nightlife, numerous diverse shops and museums and has a charming old town center. The meeting will be at the Valencia Conference Center that is located within walking distance of the downtown historical center. Meliã Valencia & Sercotel Sorolla Palace Hotels are beautiful, modern and are adjacent to the conference center. The IMAST program committee is committed to bringing another stimulating, diverse and informative scientific program.

Research Grant Committee Update

Charles E. Johnston, II, MD
Research Grant Committee Chair

The Research Grant Committee was pleased to receive 24 grant applications for the Spring 2013 Cycle.

As in the recent past two cycles, the committee chose to consider the grants separated into three team categories – clinical deformity (n=12), biomechanics and basic science (n=7), and molecular biochemistry and genetics (n=5). Each grant was reviewed by a minimum of two reviewers from each team plus an additional review from either another team leader, the committee chair, or a consultant reviewer in the case of special expertise required (for the genetics grants primarily).

Available Research funds for the cycle included $ 138,338 from the SRS general funds, a $20,000 award from the Stacy Lewis Foundation to apply to a clinical research project, and a $25,000 unrestricted grant from Medtronic. The winning grants are:

Neuroprotection against oxidative stress in a model of distraction spinal cord injury
Jennifer Seifert, PhD University of Texas at Arlington $48,300

The Grant Outcomes Subcommittee has reviewed over 10 currently funded grants for progress and continued funding, and has solicited 4 of the 2011-12 grant recipients to present interim reports at the lunchtime research symposium during the 2013 Annual Meeting in Lyon. Those projects include:

Toward the etiology of Idiopathic Scoliosis Using the Distribution Patterns of Quantitative MR Parameters Within the Intervertebral Discs as Predictive Factors of ProgressionDelphine Perie-Curnier, PhD

A Novel Approach to use Surface Topography Results for Assessing ScoliosisEric Parent, PhD

Global Outreach Committee Update

Youssry M.K. El-Hawary, MD
Global Outreach Committee Chair

Dear SRS Members,

It has been a year since I chaired The Global Outreach Committee (GOC). Despite the effort that I have done, I still feel that I could have done more. The GOC is an important channel for SRS going global. There is a lot that we can offer the under served patients and surgeons. The two new comers to the GOC sites have been busy this year, namely the Hani Mhaidli, MD team in Marrakech, Morocco and the Elhawary, MD team in Sanaa, Yemen. Ted Wagner, MD made several visits to Indonesia, another active site.

I would like to encourage all members to take part in GOC by either joining the committee or starting a site in an area in need. The best time I spend is when visiting the sites. You see different pathologies, new places, meet interesting people, teach young surgeons, treat patients and overall, your work and time is very much appreciated. So, what more you could wish for (see photos).

The GOC is holding a Lunchtime Symposium this year at the 48th Annual Meeting & Course in Lyon, where you will meet the members of the SRS Global Outreach Committee and representatives from the SRS Endorsed Sites. The Lunchtime Symposium is titled "Update on How to Start and Treat a Site". This symposium will be informative for anyone who has ever thought about volunteering their skills and knowledge in another country or wants to learn about some of the current treatment of less common conditions such as Pott's disease or untreated severe scoliosis. During the symposium, representatives from SRS Endorsed Sites will report on last year's activities at some of the sites where they have volunteered, including Western and Eastern Africa, South and Central America, India and Asia, and Eastern Europe. If you have already been involved in Global Outreach in spinal deformity care, this is an excellent opportunity to network with colleagues.

Morbidity and Mortality Committee Update

Douglas C. Burton, MD
Morbidity and Mortality Committee Chair

2012 M&M Data Collection Presented at the 48th Annual Meeting & Course in Lyon, France
On Friday, September 20, at 7:09-7:16 AM in Forum 4 at the Cite Centre de Congres, Lyon, France (during the Members’ Business Meetings), Dr. Burton will present the results of our 2012 M&M data collection, compare and contrast the results with past collection years and glean the pros and cons. After the Annual Meeting, the general 2012 M&M results will be posted on the members-only site.

Time Clock Increase on M&M Collection Site
Good news! The time limit has increased to 30 minutes, from 15 minutes, while entering M&M data! Remember, each time you click the “Click to save data and update totals” button at the bottom of the grid page your data will be saved and the timer will restart to an additional 30 minutes.

New Discrepancy Report for Complications
In an effort to continue to monitor the accuracy of data entered, we have created and implemented a discrepancy report. Your online M&M report will now be flagged for a discrepancy when the sum from the grid page does not match what has been entered in the “record complication” section or when the sum from the “record complication” section does not match the complication number(s) entered on the grid page. Therefore, all numbers entered under the complication columns in the grid page must match up with what is recorded in detail and vise versa.

For example:

You entered three acute infection cases on the grid page, under the infection column, when you began reporting, however, you only recorded the details on two of the cases thinking you would go back and enter the third case before the deadline but never did; your report will be flagged with a discrepancy.

You recorded complication details on two cases of visual acuity loss but did not record them on the grid page, under the visual acuity loss column; your report will be flagged with a discrepancy.

You entered one death and one neurologic deficit case on the grid page but never recorded any complication details in the “record complication” section; your report will be flagged with a discrepancy.

How do I know if I have a discrepancy in my reporting?
There are three ways you are alerted of a discrepancy in your reporting.

You will not be allowed to attest your report and will be asked to review your to-do-list.

Down fall: you do not attest your report at all or wait until right before the deadline to attest; hence you will not know about the discrepancy and/or will not have time to fix it.

You will be contacted via email by the SRS office to fix the discrepancy.

Down fall: you do not open your emails from the SRS office.

Down fall: you do not forward the message to the person in your office that does the reporting for you.

Your to-do-list will inform where the discrepancy is.

Snap shot of the to-do-list from M&M site:

To-Do-List
This section indicates the difference between what was recorded on the grid page and what has been recorded in the “record complication” section.

• You have to record 1 more complication case(s) resulting in death.

• You have to record 1 more complication case(s) with neurological deficit.

• You have to record 2 more complication case(s) resulting in visual acuity loss.

• You have to record 1 more complication case(s) with acute infection.

How do I fix the discrepancy?

Review your to-do-list to verify where the problem is.

Go back in to your M&M report and make the pertinent changes and save again.

After fixing your discrepancy you will be allowed to attest your report and your to-do-list will revert back to zero, meaning that your complications recorded match-up with what is listed on the grid page.

Please be aware that you will be contacted via email sometime in January to fix any discrepancies. This will allow you three months to fix any issues and to attest your report after the issues have been fixed.

Hard Copy Complication Data Questionnaire for Download (coming in October)
Per member request, we have created a hard copy complication data questionnaire that contains all of the complication questions from the online system. We hope that this document will make record keeping easier and will increase the accuracy of reporting.

Revisiting the Definitions of Complication Terms
In an effort to be clear on what to enter in the complication sections the committee created definition of terms. Please let us know if you have any questions.

Death: Death that is attributable to a complication of the surgery or occurred during the surgical event. Current module goes for >21 days if in fact traceable to the surgery or lingering complication.

Visual acuity loss (formally termed blindness): Any change in visual acuity listed by time of identification within the hospital stay. Classification by pathology usually requiring specialty consultation.

Neurologic deficit (formally termed paralysis): Any change in the spinal cord, nerve roots, or peripheral nerves apparent within the time frames listed in the module.Acute infection: Acute Infections that occur at the operative site in the post operative period of up to 12 weeks.

Please remember that if and when you enter any complications you must fully completethe detailed modules for each complication in the “record complication” section. If not, your report will be flagged with a discrepancy.

Our data collection is only as good as the information that is entered, correctly!! Please, please pay special attention.

Request for Proposal (RFP) for M&M Data Research
A special member benefit is the opportunity to glean M&M data for your own research. A couple of years ago the Board of Directors agreed to fund data extraction from the M&M database for individual research.

In an effort not to duplicate projects we have provided a list of current research. There is also a bibliography of published papers using the M&M database, which demonstrates the usefulness and value of our M&M collection process as well as to serve as a guide to future researchers as they consider studies using the M&M database.

The next three deadlines for M&M RFP’s are:

Request for Proposal Deadline

Notification

M&M Data Delivered Via Email

September 1

October 1

November 1

November 1

December 1

January 1

January 1

February 1

March 1

The process and guidelines for submitting an RFP is located on the Members-Only section of the SRS website under Morbidity and Mortality.

Ethics Corner: Ethical Issues in the Use of Social Media

James W. Roach, MD
Ethics and Professionalism Committee Chair

Social media is broadly defined as communicating with others using electronic medium through a computer, tablet, or phone. This technology has greatly expanded the various ways people can interact with one another. Using social media technology, individuals can easily communicate with friends, family, and co-workers in an almost immediate manner. Because this provides such incredible efficiency and accessibility, multiple forms of social media have been fully embraced by society, especially the younger generation. The use of social media does present certain concerns especially for physicians. However social media is merely a form of communication and the standards for professional behavior should remain consistent across all the various interactions between physicians and patients. The hallmark of professional behavior is maintaining patient trust and confidentiality. The remainder of this article summarizes the conclusions reached by the policy statement from the American College of Physicians and the Federation of State Medical Boards regarding physician use of social media.1

Physicians have the opportunity to use social media in several different ways. The most obvious is for clinical purposes and there are four general ways to use social media in this manner.

Direct Patient Care
The speed of communicating directly with patients about specific medical questions is very appealing and if properly implemented, can improve the patient/physician relationship. Since this communication is outside of the electronic medical record, many privacy issues can occur. Physicians who offer this type of direct patient communication should establish an agreement with the patient covering how the information will be transmitted, the type of healthcare information that will be imparted, the expected response time, the possibility of loss of confidentially, and the requirement that the patient also maintains face to face follow up visits. In addition the physician should consider the possibility that an electronic message which crosses state lines could violate state licensing requirements.

Examples of this type of direct patient care communication would be email, texting, and instant messaging. Misunderstanding the presented information is a major risk with non-face to face interactions and shorter messages probably increase this risk. The use of email through a secure, protected server is preferable with the less secure texting and instant messaging more compromised as a form of communication. Most medical institutions host encrypted sites that permit safe email communication with patients. In addition these sophisticated networks often have mobile device management systems to disable phones, tablets, or computers that become lost or stolen.

Providing Valid Medical Educational Information (Not Direct Patient Care)
Physicians can also develop electronic mechanisms to share valid medical information with individuals who may or may not be current patients. Typically a physician will develop a website which has links to a medical society or a specialty association website where the medical information is reliably peer reviewed. This is a significant benefit to individuals who seek reliable medical information. However the physician is responsible to vet the content and refer patients to reputable sites. Information on a physician’s website also must be truthful and accurate. Claims of treatment outcomes that are untruthful, misleading, or deceptive are illegal as they would violate the FTC Act (15 U.S.C. Sect. 45), truth in advertising. Statements on a physician’s website that use the phrases “painless”, “safe” or “effective”, “cure”, and “bloodless” are especially concerning. Likewise hyperbole regarding a physician’s qualifications and using terms such as “world famous”, “top surgeon”, and “pioneer” are best avoided. The SRS wants all members to interact truthfully and honestly in all situations.

Interacting With Medical Colleagues
Physicians use electronic means to discuss medical issues with colleagues. These are usually sites maintained and secured by medical or specialty societies. Postings then attract comments and suggestions from the other society members. This is a secure and proper way to seek advice from other colleagues. Posting on unsecure sites is best avoided.

Public Blogs Focused on Medical Issues
There are multiple public sites were medical issues are discussed. These are not secure and individual healthcare information should never be included in any communications on these sites. In many instances these public blogs drift far afield of the original issue and become forums for venting by ranting, unhappy people. A physician comment on a public blog is likely retrievable and may be embarrassing if the blog’s subsequent commenters stray into an inappropriate discussion. Avoiding these sites is probably prudent.

Non-medical Social Media
Physicians can also participate in social media in a purely personal manner. Examples of these social media venues would be Facebook, YouTube and Twitter. While many physicians participate on these sites it is best to keep personal information private and not “friend” patients. This is especially in case when pictures are included that might be misunderstood by the public, cell phone photos in the OR are sent, or a medical skit is uploaded to a video site. The public does not always interpret medical humor as harmless. Posted comments on social media can now be indexed by Google, permitting indiscretions to live forever.

The “contract” between physicians and the public centers on professionalism and the physician is expected to maintain high ethical standards and not display poor judgment. An individual physician who does something inappropriate will suffer the public’s negative impression but unfortunately the physician’s action also diminishes society’s trust in the entire profession.

Spinal Instrumentation – Coding for Insertion and Removal

There are several CPT Codes which involve removal of hardware. These include:

22849 - Reinsertion of spinal fixation device

22850 - Removal Posterior non-segmental instrumentation

22852 - Removal Segmental posterior instrumentation

22855 - Removal Anterior instrumentation

Recently CPT has issued new explanatory language for these codes:

“Codes 22849, 22850, 22852, and 22855 are subject to modifier 51 if reported with other definitive procedure(s), including arthrodesis, decompression, and exploration of fusion. Code 22849 should not be reported in conjunction with 22850, 22852, and 22855 at the same spinal levels.

Only the appropriate insertion code (22840 -22848) should be reported when previously placed spinal instrumentation is being removed or revised during the same session where new instrumentation is inserted at levels including all or part of the previously instrumented segments.

Do not report the reinsertion (22849) or removal (22850, 22852, and 22855) procedures in addition to the insertion of the new instrumentation (22840-22848).”
The guidelines also specify that reinsertion (22849) and/or removal (22850) should not be additionally reported with insertion of new instrumentation (22840-22848). Instead, the intent is that when insertion of instrumentation is performed that involves the original levels as well as new levels, only the appropriate code for the type of instrumentation (anterior or posterior) should be used according to the level(s) of instrumentation performed for the procedure.

In other words:

The removal codes (22850, 22852, and 22855) should be used when taking out hardware is all that is being done and not used when insertion or reinsertion is performed.

The reinsertion code (22849) should be used when hardware is going back in at the same levels/location (i.e. for failed hardware, nonunion, etc.). Reinsertion includes removal (22850, 22852, and 22855).

The insertion codes (22840-22848) are used when new hardware is put in which “exceeds” the previously placed hardware. The insertion codes include removal (22850, 22852, and 22855).

Public Relations Update

Lori Karol, MD
Public Relations Committee Chair

Since our last update, the public relations committee has had significant activity. In April, a public service announcement poster featuring WPGA golfer Stacy Lewis was produced in conjunction with the American Academy of Orthopaedic Surgeons (AAOS) Nation in Motion campaign (see below). Ms. Lewis serves as a spokesperson for the SRS, has generously supported research, and is prominently featured on our website. Stacy Lewis’s story was featured on CNN News on June 6, with links to the Scoliosis Research Society included in the text. This month, Stacy won the Women’s British Open at St. Andrews with birdies on her last two holes.

In May, professional golfer Ken Duke visited Texas Scottish Rite Hospital and participated in a photo shoot with scoliosis patients and past-president Steve Richards. This is posted on the SRS website.

On June 8, sportscaster Ken Rosenthal of Fox Sports wore a “bow tie” as part of the Bow Tie Cause program raising awareness for scoliosis and the Scoliosis Research Society on the telecast of the Boston Red Sox baseball game. He wore the tie, designed using a pattern from the original 1966 SRS logo, in honor of his daughter who underwent scoliosis surgery in 2011. The story, and more information on the Bow Tie Cause, is featured on our website and the SRS Facebook page.

June was Scoliosis Awareness Month. Electronic files of posters cosponsored by the SRS were posted and are available for download on the Scoliosis Awareness page of the SRS website. Our hospital, Texas Scottish Rite Hospital for Children, displayed these posters on the clinic level for the public to view.

Finally, the public relations committee would like to encourage the membership to submit patient vignettes for publication on the SRS website. Information regarding the format for patient stories and forms for release of information are available through the SRS office. Please contact Shahree Douglas for more information.

Growing Spine Committee Update

Michael Mendelow, MD
Growing Spine Committee Chair

The Growing Spine Committee has fulfilled several charges over the past two years, including a white paper on Growing Spine, now published, and a rewrite of the website material on growing spine. This year, there are several projects the Growing Spine Committee has taken on in a reorganization and clarification of committee charges. We have also been working on other committee assignments including a consensus statement for Growing Spine, and an illustrated glossary to accompany the new website material.

Opportunities for collaboration with other committees have also been initiated. Among these is the provision of material to the coding committee to support an effort to appropriately value Mehta casting. A plan has been developed with the Patient Education Committee to create a new growing spine section for a new Spine Deformity brochure they are working on. We have rearranged the existing growing spine content of the E-text for the new I-pad version and, with the E-text committee, are considering an update and rewrite of the growing spine content of the E-text.

Also, we have initiated a plan to begin to engage the American Academy of Pediatrics (AAP) in the area of growing spine. SRS members are encouraged to join the AAP orthopaedic section and to look forward to further growing spine and AAP news in the coming year.

Globalization Committee Update

Lawrence G. Lenke, MD
Globalization Committee Chair

The Globalization committee developed two separate surveys that went out to representatives of our International Spinal Surgery community in late August. The first survey is directed towards SRS international members. Our objective is to obtain a better appreciation of how they feel the SRS is doing with respect to our Global aspirations, what attracted them to become an SRS member, how the benefits of membership are of value to them and their patients, what additional benefits may be of importance to them, and whether they can identify other surgeons in their regions who may be potential members in the future. In addition, we will query our non-North American members for potential future sites for our meetings held around the globe.

The second survey will be distributed to non-SRS members from around the world who have attended at least one of our meetings in the past, but have not elected, for whatever reason, to join our Society. This survey will attempt to define what meetings and aspects of those meetings were felt to be of importance to these surgeons to attend, and more importantly, why these surgeons have not joined the SRS. The goal will be to try and identify the main reasons why spinal deformity surgeons from around the globe have not joined our society even though they attend our meeting(s) and feel our educational offerings have value to them. We will try and delineate what benefits of SRS membership these surgeons would find of enough value to consider joining the SRS, if certain membership benefits could lead to application to our society. The goal is to identify and potentially better serve spinal deformity surgeons worldwide who would benefit from membership in our Society.

The results of these two surveys will be analyzed by the Globalization Committee members and the results utilized in helping plan the continuing Globalization efforts in the future. The process of truly becoming a Global society is a long term proposition which is slowly being realized along with a gradual increase in the number and percentage of non-North American members in the SRS. The three regions (Europe, Asia-Pacific, and Latin America) and the co-chairs assigned to these regions are meant to try and improve the flow of ideas and information to the leadership of the society such that our Globalization efforts are maximized now and in the future. As always, we welcome any comments and/or suggestions on how the SRS can better meet the needs of our entire membership and spinal deformity community at-large around the Globe in order to optimize the care of all spinal deformity patients.

Development Committee Update

Steven M. Mardjetko, MD, FAAP
Development Committee Chair

The Development Committee would like to thank everyone who made generous contributions to the Scoliosis Research Society (SRS) through donations to Orthopaedic Research and Education Foundation (OREF) and the Research Education Outreach (REO) Fund.